What is the recommended treatment for a male patient with newly diagnosed Major Depressive Disorder (MDD) and a 5-year history of Prostate Cancer?

From the Guidelines

For a male with prostate cancer of 5 years who is newly diagnosed with major depressive disorder, cognitive behavioral therapy (CBT) or behavioral activation (BA) would be the preferred first-line treatment options, as recommended by the most recent guideline update 1. When considering treatment, it's essential to take into account the patient's personal preferences, availability of mental health resources, and potential adverse effects.

• CBT and BA have been shown to be effective in reducing symptoms of depression and anxiety in patients with cancer, with robust effects generalizing across different demographics and disease sites 1.
• These non-pharmacologic interventions can be delivered through various modes, including in-person, virtually, or by telephone, making them more accessible to patients with limited mobility or those living in remote areas.
• While pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRIs), may be considered in certain cases, the evidence for its effectiveness in patients with cancer is not as compelling, and it is not recommended as a first-line treatment 1.
• Regular follow-up is crucial to monitor treatment response and adjust the treatment plan as needed, taking into account the patient's overall well-being and quality of life.
• The American College of Physicians also recommends discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient when selecting between CBT or second-generation antidepressants 1.
• Additionally, the American Society of Clinical Oncology guideline adaptation highlights the importance of addressing depressive and anxiety symptoms in patients with cancer, as untreated psychiatric comorbidities can lead to poorer outcomes, including increased risk of premature mortality and cancer death 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1. 1 Major Depressive Disorder (MDD) Bupropion hydrochloride extended-release tablets (XL) are indicated for the treatment of major depressive disorder (MDD), as defined by the Diagnostic and Statistical Manual (DSM) The efficacy of the immediate-release formulation of bupropion was established in two 4-week controlled inpatient trials and one 6-week controlled outpatient trial of adult patients with MDD The efficacy of the sustained-release formulation of bupropion in the maintenance treatment of MDD was established in a long-term (up to 44 weeks), placebo-controlled trial in patients who had responded to bupropion in an 8-week study of acute treatment [see Clinical Studies (14.1)].

Bupropion can be used for the treatment of Major Depressive Disorder (MDD) in a male with prostate cancer.

• The recommended starting dose for MDD is 150 mg once daily in the morning.
• After 4 days of dosing, the dose may be increased to the target dose of 300 mg once daily in the morning 2. Note: There is no direct information in the provided drug labels regarding the use of bupropion in patients with prostate cancer.

From the Research

Treatment Options for Major Depressive Disorder

• For a male patient with prostate cancer, the treatment of major depressive disorder (MDD) should be carefully considered, taking into account the potential interactions between antidepressants and cancer outcomes 3.
• The American College of Physicians recommends monotherapy with either cognitive behavioral therapy or a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder 4.
• Second-generation antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors, and others, have been shown to be effective in treating MDD, but the evidence guiding the selection of an SGA based on accompanying symptoms of depression is limited 5.

Antidepressant Options

• A systematic review and network meta-analysis found that desvenlafaxine, paroxetine, venlafaxine, and vortioxetine had reasonable efficacy, acceptability, and tolerability in the treatment of adults with stable MDD 6.
• These antidepressants may be considered as options for the treatment of MDD in a male patient with prostate cancer, but the potential risks and benefits should be carefully weighed, and the patient's specific symptoms, comorbidities, and concomitant medication use should be taken into account.

Considerations for Patients with Prostate Cancer

• A study found that untreated depressive disorders in prostate cancer patients may be associated with an increased risk of biochemical recurrence 3.
• Therefore, it is essential to treat MDD in patients with prostate cancer, and the choice of antidepressant should be based on the individual patient's needs and circumstances.
• Further research is needed to fully understand the relationship between antidepressant use and cancer outcomes in patients with prostate cancer.